A routine ENT procedure, such as adenoidectomy, is performed under indirect, mirror-aided visualization. FIG. 1 illustrates a conventional ENT procedure with mirror-aided visualization of the surgical field. Alternatively, several different types/sizes of mouth gags are currently employed in the routine ENT procedures. The conventional mouth gag, such as the most commonly used Crowe-Davis and McIvor mouth gags, includes a mouth gag frame and an attachable tongue depressor, whereas the tongue depressor comprises a tongue-covering blade and handle piece to attach to the mouth gag frame. FIG. 2 illustrates a Crowe-Davis mouth gag with a frame and a tongue depressor/blade, whereas the tongue depressor/blade further comprises a rigid groove/indentation on the backside for the passage of an intubation tube between the depressor and the tongue. However, no accommodation is made on any conventional tongue depressor/blade for secure placement of an optic device, such as a fiber optic rigid or flexible endoscope. Rather, during contemporary upper airway procedures (such as nasopharyngeal procedures), a handheld mirror is still used by a surgeon, providing poor imaging quality and limited surgical field viewing. As a result, the surgical field, in such cases, is limited and not magnified, which prevents proper visualization of the surgical field by a surgeon, OR nursing staff, technicians, students and residents. In addition, and most importantly, the handheld mirror occupies a surgeon's non-operating hand.
Endoscopic technology has been increasingly sophisticated to provide high-definition visual monitoring during many types of surgical procedures. Several attempts to combine the endoscopic technology and the existing ENT devices, such as a mouth gag, have been developed and studied; however, most of them are rather cumbersome, and/or focused on developing the direct-line-of-sight from a surgeon's eye to the larynx of a patient. For example, an optical design currently used in robotic surgery, da Vinci Robotic Surgery, is illustrated in FIG. 3. However, the illustrated setup has proven to be cumbersome, significantly limits manual accessibility, and requires a lengthy training to operate. Furthermore, the illustrated robotic surgery, as of now, cannot be utilized for nasopharyngeal surgery, since the adenoids are tucked away in the nasopharynx, located in the opposite direction (˜180°) from the larynx, and behind the soft palate, a difficult location to access.
Previously, Dr. Gov-Avi, one of the present inventors, has disclosed a device/method in U.S. Patent Application No. 61/796,514 to incorporate endoscopic means with the conventional mouth gag to provide a clinician with an enhanced viewing of the surgical field during a nasopharyngeal or other ENT surgery. '514 device includes a modified tongue blade with an additional groove/indentation to accommodate the placement of an endoscopic means, as illustrated in FIG. 4a and FIG. 4b. However, the support/adjustment of the endoscopic means remains manual. This endoscopic-enabled tongue depressor is shown in U.S. Patent Application Publication No. 2014/0180006, filed as U.S. patent application Ser. No. 14/079,265 on Nov. 13, 2013, and published Jun. 26, 2014, as “Endoscopic-Enabled Tongue Depressor and Associated Method of Use,” which is incorporated by reference herein in its entirety.
Therefore, there is a need to provide a new and improved endoscopic-enabled mouth gag with adjustable support of the endoscopic device to provide enhanced visualization of the surgical field and to enable a clinician to utilize both hands during an ENT surgery.